TY - JOUR
KW - Adult
KW - Aged
KW - Amphetamine-Related Disorders/psychology/therapy
KW - Counseling/methods
KW - HIV Infections/prevention & control/psychology
KW - Homosexuality, Male/psychology
KW - Humans
KW - Male
KW - Methamphetamine
KW - Middle Aged
KW - Motivational Interviewing/methods
KW - Pilot Projects
KW - Risk Reduction Behavior
KW - Sexual and Gender Minorities/psychology/statistics & numerical data
KW - Unsafe Sex/psychology/statistics & numerical data
KW - Behavioral Activation
KW - HIV risk
KW - crystal methamphetamine dependence
KW - Men who Have Sex with Men
KW - sexual risk reduction
AU - M. J. Mimiaga
AU - D. W. Pantalone
AU - K. B. Biello
AU - J. M. W. Hughto
AU - J. Frank
AU - C. O'Cleirigh
AU - S. L. Reisner
AU - A. Restar
AU - K. H. Mayer
AU - S. A. Safren
A1 - 
AB - Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = -0.36; 95% CI: -0.69, -0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = -0.95; 95% CI: -1.44, -0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = -0.87; 95% CI: -1.38, -0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.
AD - a Center for Health Equity Research , Brown University , Providence , RI , USA.; b Departments of Behavioral & Social Health Sciences and Epidemiology, School of Public Health , Brown University , Providence , RI , USA.; c Department of Psychiatry and Human Behavior , Brown University Alpert Medical School , Providence , RI , USA.; d The Fenway Institute , Fenway Health , Boston , MA , USA.; d The Fenway Institute , Fenway Health , Boston , MA , USA.; e Department of Psychology , University of Massachusetts , Boston , MA , USA.; a Center for Health Equity Research , Brown University , Providence , RI , USA.; b Departments of Behavioral & Social Health Sciences and Epidemiology, School of Public Health , Brown University , Providence , RI , USA.; d The Fenway Institute , Fenway Health , Boston , MA , USA.; d The Fenway Institute , Fenway Health , Boston , MA , USA.; f Department of Epidemiology , Yale University School of Public Health , New Haven , CT , USA.; a Center for Health Equity Research , Brown University , Providence , RI , USA.; b Departments of Behavioral & Social Health Sciences and Epidemiology, School of Public Health , Brown University , Providence , RI , USA.; c Department of Psychiatry and Human Behavior , Brown University Alpert Medical School , Providence , RI , USA.; d The Fenway Institute , Fenway Health , Boston , MA , USA.; g Department of Psychiatry, Behavioral Medicine Service, Harvard Medical , School/Massachusetts General Hospital , Boston , MA , USA.; d The Fenway Institute , Fenway Health , Boston , MA , USA.; h Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA.; i Department of Pediatrics , Harvard Medical School , Boston , MA , USA.; j Department of Epidemiology , Harvard T. H. Chan School of Public Health , Boston , MA , USA.; a Center for Health Equity Research , Brown University , Providence , RI , USA.; b Departments of Behavioral & Social Health Sciences and Epidemiology, School of Public H(TRUNCATED)
BT - AIDS Care
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 9
DO - 10.1080/09540121.2019.1595518
IS - 9
JF - AIDS Care
LA - eng
M1 - Journal Article
N2 - Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = -0.36; 95% CI: -0.69, -0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = -0.95; 95% CI: -1.44, -0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = -0.87; 95% CI: -1.38, -0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.
PY - 2019
SN - 1360-0451; 0954-0121; 0954-0121
SP - 1083
EP - 1095
EP - 
T1 - An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men
T2 - AIDS Care
TI - An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men
U1 - Healthcare Disparities; Opioids & Substance Use
U2 - 30887824
U3 - 10.1080/09540121.2019.1595518
VL - 31
VO - 1360-0451; 0954-0121; 0954-0121
Y1 - 2019
Y2 - Sep
ER -